This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gridelli, C. Articles by Langer, C. Search for Related Content PubMed PubMed Citation Articles by Gridelli, C. Articles by Langer, C.

Treatment of Advanced Non–Small-Cell Lung Cancer in the Elderly: Results of an International Expert Panel

From the Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino; Division of Medical Oncology, Azienda Ospedaliera Universitaria, Parma; 5th Pulmonary-Oncology Unit, Lung Diseases Department, Forlanini Hospital, Rome; Clinical Trials Unit, National Cancer Institute, Napoli, Italy; Multidisciplinary Oncology Institute, Clinique de Genolier, Switzerland; Division of Medical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Division of Medical Oncology, University of Colorado Cancer Center, Denver, CO; Department of Medicine, Istitute Gustave Roussy, Villejuif, France; Department of Medical Oncology, Thoraxklinik, Heidelberg, Germany; Department of Medical Oncology, Institut Català d'Oncologia, Barcelona, Spain; Department of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; and Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests Cesare Gridelli, MD, Division of Medical Oncology, "S.G. Moscati" Hospital, Via Circumvallazione 68, 83100 Avellino, Italy; e-mail: cgridelli{at}libero.it

The best treatment for elderly patients with advanced non–small-cell lung cancer (NSCLC) is still debated. To guide clinical management of these patients and suggest the priorities for clinical research in this field, an International Expert Panel met in Naples, Italy, on April 19 to 20, 2004. Results and conclusions based on a review of evidence available in the literature to date are presented in this article. A comprehensive geriatric assessment is recommended to better define prognosis and to predict tolerance to treatment. In the first randomized study dedicated to elderly NSCLC patients, single-agent vinorelbine showed superiority over supportive care alone, both in terms of survival and quality of life. In a large randomized trial, gemcitabine plus vinorelbine failed to show any advantage over either agent alone. Subset analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with an acceptable increase in toxicity for elderly patients. These data should be interpreted cautiously because retrospective subgroup analyses are encumbered by selection bias; hence, randomized trials dedicated to platinum-based chemotherapy for nonselected elderly patients are warranted. Several promising biologic therapies are under investigation; however, with present data, target-based agents as first-line treatment for elderly NSCLC patients are not yet recommended. Clinical research, with trials specifically designed for elderly patients, is mandatory. With the current evidence, single-agent chemotherapy with a third-generation drug (vinorelbine, gemcitabine, a taxane) should be the recommended option for nonselected elderly patients with advanced NSCLC. Platinum-based chemotherapy is a viable option for fit patients with adequate organ function. Best supportive care remains important, in addition to chemotherapy or as the exclusive option for patients who are unsuitable for more aggressive treatment.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				P. Wheatley-Price, K. Ding, L. Seymour, G. M. Clark, and F. A. Shepherd Erlotinib for Advanced Non-Small-Cell Lung Cancer in the Elderly: An Analysis of the National Cancer Institute of Canada Clinical Trials Group Study BR.21 J. Clin. Oncol., May 10, 2008; 26(14): 2350 - 2357. [Abstract] [Full Text] [PDF]

				C. Gridelli Treatment of Advanced Non Small-Cell Lung Cancer in the Elderly: From Best Supportive Care to the Combination of Platin-Based Chemotherapy and Targeted Therapies J. Clin. Oncol., January 1, 2008; 26(1): 13 - 15. [Full Text] [PDF]

				T. R. Asmis, K. Ding, L. Seymour, F. A. Shepherd, N. B. Leighl, T. L. Winton, M. Whitehead, J. N. Spaans, B. C. Graham, and G. D. Goss Age and Comorbidity As Independent Prognostic Factors in the Treatment of Non-Small-Cell Lung Cancer: A Review of National Cancer Institute of Canada Clinical Trials Group Trials J. Clin. Oncol., January 1, 2008; 26(1): 54 - 59. [Abstract] [Full Text] [PDF]

				J. P. Sculier, J. J. Lafitte, M. Paesmans, J. Lecomte, C. G. Alexopoulos, O. Van Cutsem, V. Giner, A. Efremidis, M. C. Berchier, T. Collon, et al. Chemotherapy improves low performance status lung cancer patients Eur. Respir. J., December 1, 2007; 30(6): 1186 - 1192. [Abstract] [Full Text] [PDF]

				C. Gridelli, P. Maione, A. Illiano, F. V. Piantedosi, A. Favaretto, A. Bearz, S. F. Robbiati, V. Filipazzi, V. Lorusso, F. Carrozza, et al. Cisplatin Plus Gemcitabine or Vinorelbine for Elderly Patients With Advanced Non Small-Cell Lung Cancer: The MILES-2P Studies J. Clin. Oncol., October 10, 2007; 25(29): 4663 - 4669. [Abstract] [Full Text] [PDF]

				S. M. Lichtman, L. Balducci, and M. Aapro Geriatric Oncology: A Field Coming of Age J. Clin. Oncol., May 10, 2007; 25(14): 1821 - 1823. [Full Text] [PDF]

				C. Pepe, B. Hasan, T. L. Winton, L. Seymour, B. Graham, R. B. Livingston, D. H. Johnson, J. R. Rigas, K. Ding, and F. A. Shepherd Adjuvant Vinorelbine and Cisplatin in Elderly Patients: National Cancer Institute of Canada and Intergroup Study JBR.10 J. Clin. Oncol., April 20, 2007; 25(12): 1553 - 1561. [Abstract] [Full Text] [PDF]

				C. Gridelli, P. Maione, and A. Rossi Single-Agent Chemotherapy for the Treatment of Elderly Patients With Advanced Non-Small-Cell Lung Cancer: What Is the Best Drug? J. Clin. Oncol., April 10, 2007; 25(11): 1444 - 1445. [Full Text] [PDF]

				G. Giaccone The Potential of Antiangiogenic Therapy in Non-Small Cell Lung Cancer Clin. Cancer Res., April 1, 2007; 13(7): 1961 - 1970. [Abstract] [Full Text] [PDF]

				C. J. Langer Mind Your Elders: Therapeutic Implications of Epidermal Growth Factor Receptor Inhibition in Older Patients With Advanced Non-Small-Cell Lung Cancer J. Clin. Oncol., March 1, 2007; 25(7): 751 - 753. [Full Text] [PDF]

				Practice Notes: Strategies in Health Education Health Educ Behav, February 1, 2006; 33(1): 5 - 9. [PDF]

				H. Wakelee and C. P. Belani Optimizing First-Line Treatment Options for Patients with Advanced NSCLC Oncologist, October 1, 2005; 10(suppl_3): 1 - 10. [Abstract] [Full Text] [PDF]